Bariatric device and method

ABSTRACT

A bariatric device and procedure configured to control the amount of food and nutrients entering a person&#39;s duodenum and reduce the weight of the person, in one aspect, comprises a gastrostomy tube having a proximal end and a distal end; a feeding tube assembly, said assembly including a feeding tube having a proximal end and a distal end; a gastrostomy tube anchor for securing the distal end of said gastrostomy tube inside the stomach; and a first feeding tube anchor designed to be expanded after the pyloric sphincter so as to anchor the distal end of said feeding tube in the duodenum.

This application claims benefit under 35 U.S.C. §119(e) of U.S.Provisional Application No. 62/016,921, filed 25 Jun. 2014, the contentsof which are incorporated herein by reference in their entirety.

TECHNICAL FIELD

The disclosure relates generally to a bariatric device and method. Morespecifically, the disclosure is directed to a combinationtrans-abdominal feeding and stomach aspirating device and methods of usefor weight loss and obesity treatment.

BACKGROUND

The information provided below is not admitted to be prior art to thepresent invention, but is provided solely to assist the understanding ofthe reader.

Obesity is a major public health issue in the United States. The obesityrate in the United States is among the highest in the world as one outof every three Americans is now considered obese. Obesity has led toover approximately 120,000 preventable deaths and has been cited as acontributing factor to another estimated 100,000-400,000 annual deathsin the United States. Unfortunately, many Americans are unable to or donot adequately control their weight and require medical intervention tolose weight, while many others desire to lose weight for variousaesthetic reasons.

Numerous medical devices and surgical procedures for cosmetic weightreduction and the treatment of obesity have been proposed. Gastricbypass procedures are one of the most commonly employed bariatricsurgeries in the United States. These procedures typically involve thedivision of the stomach into a small pouch and a large pouch, andresection or rerouting of the small intestines to the small pouch tolimit the volume of food a person can consume before reaching satiation;the theory being that the smaller the useable stomach volume, the lowerthe calories that can be absorbed by the body. Other options includesleeve gastrectomy and gastric banding surgery, which generally involvesurgical removal of a large portion of the stomach or mechanicalreduction of the size of the stomach, respectively. Still yet otheroptions include direct, controlled feeding into the gastrointestinaltract using an enteral feeding tube alone or in conjunction with anaspirating device for removing excess food from the stomach. Forexample, one such device is disclosed in U.S. Pat. No. 4,543,089.

However, existing weight reduction devices and procedures are veryinvasive, have considerable recovery times, often cause nutritionaldeficiencies, and offer only limited success because they do not causethe subject to permanently change his or her eating habits. In addition,trans-abdominal gastrointestinal feeding and aspirating devices andprocedures are prone to clogging by particulate and solid foods and solimit the volume and consistency of food that can be eaten and removedfrom the stomach. Moreover, such devices can become dislodged easily andcannot be readily adjusted or accessed.

Therefore, a need exists for an improved trans-abdominal bariatricdevice and procedure that can control the amount of food and nutrientspassing out of a person's stomach to the duodenum and permit the removalof excess food from the stomach. In addition, what is needed is an easyto install, minimally invasive bariatric device which may be adjusted orreplaced and which will not easily become dislodged from a person'sstomach. It is also an object of the present disclosure to provide abariatric device having a minimal number of separate tubes and or partsinside a person's body. Other objects and advantages will becomeapparent from the following disclosure.

SUMMARY

The present disclosure provides devices and methods for reducing theweight of overweight and obese individuals. More specifically, thedisclosure provides bariatric devices and procedures for simultaneouslyfacilitating weight loss and improving healthy eating behaviors whiledelivering proper nutrition to a person.

In one aspect of the disclosure, a bariatric device comprises: agastrostomy tube having a proximal end and a distal end; a feeding tubeassembly (optionally at least partially nested within said gastrostomytube), said assembly including a feeding tube having a proximal end anda distal end; a gastrostomy tube anchor attached to said gastrostomytube and designed to be expanded inside a person's stomach at thestomach wall to secure the distal end of said gastrostomy tube insidethe stomach; and a first feeding tube anchor attached to said feedingtube assembly, said first feeding tube anchor designed to be expandedinside a person's pyloric sphincter (i.e. positioned and expandedbeyond/after the pyloric sphincter, within the intestine) so as tosecure the distal end of the feeding tube in a person's duodenum.Advantageously, both the gastrostomy tube and feeding tube of thebariatric device can be secured/anchored within a patient, whichsignificantly reduces the chances of the tubes becoming dislodged in aperson's stomach. Furthermore, the use of independent anchors for thegastrostomy tube and feeding tube assembly allows the tubes to bemanipulated individually, permitting simple and minimally invasiveremoval and replacement of device components (for example, it ispossible for the gastrostomy tube to be removed and replaced whilst thefeeding tube remains anchored in position, and vice versa).

Optionally, the gastrostomy tube anchor is a gastrostomy balloon whichis designed to be inflated inside a person's stomach. Optionally, thefirst feeding tube anchor is a first feeding tube balloon designed to beinflated inside/after a person's pyloric sphincter, and the feeding tubeassembly includes a first balloon inflation tube, wherein the firstfeeding tube balloon is in communication with said first ballooninflation tube.

Optionally, the bariatric device further comprises a second feeding tubeanchor attached to said feeding tube assembly, designed to be positionedand expanded outside/before the pyloric sphincter so as to secure thedistal end of the feeding tube in a person's duodenum in conjunctionwith said first feeding tube anchor. In such embodiments, the secondfeeding tube anchor may be a second feeding tube balloon designed to bepositioned and inflated before a person's pyloric sphincter, and thefeeding tube assembly optionally includes a second balloon inflationtube, wherein the second feeding tube balloon is in communication withsaid second balloon inflation tube.

The bariatric device may comprise: a gastrostomy tube having a proximalend and a distal end; a feeding tube assembly at least partially nestedwithin said gastrostomy tube, said assembly including a feeding tubehaving a proximal end and a distal end, and first and second ballooninflation tubes; a gastrostomy balloon attached to said gastrostomy tubeand designed to be inflated inside a person's stomach at the stomachwall to anchor the distal end of said gastrostomy tube inside thestomach; and first and second feeding tube balloons in communicationwith said first and second balloon inflation tubes, said first balloondesigned to be inflated inside a person's pyloric sphincter and saidsecond balloon designed to be inflated outside a person's pyloricsphincter so as to anchor the distal end of the feeding tube in aperson's duodenum. Using first and second feeding tube balloons whichcan be inflated on either side of a person's pyloric sphincter allowsboth forwards and backwards motion of the feeding tube through thepyloric sphincter to be restricted, and thus provides a way of securingthe feeding tube at a desired position within the duodenum.

In another aspect of the disclosure, the invention provides a feedingtube device, comprising a feeding tube assembly and feeding tubeanchor(s) as described herein. For example, the feeding tube devicecomprises: a feeding tube having a proximal end and a distal end, afirst balloon inflation tube, and a first feeding tube balloon incommunication with said first balloon inflation tube, said first balloondesigned to be inflated after a person's pyloric sphincter so as toanchor the distal end of said feeding tube in a person's duodenum. Insuch embodiments, the feeding tube device may further comprise a secondfeeding tube balloon, wherein the first and second feeding tube balloonsare designed to be inflated on either side of a person's pyloricsphincter so as to anchor the distal end of said feeding tube in aperson's duodenum. In such embodiments, the feeding tube device suitablyincludes a second balloon inflation tube, and the second feeding tubeballoon is in communication with said second balloon inflation tube.

In another aspect of the disclosure, a gastrostomy tube comprises aproximal and a distal end, a sidewall, and a tube support channel on orin the sidewall for receiving a feeding tube assembly, and furthercomprising a gastrostomy tube anchor attached to said gastrostomy tubeand designed to be expanded inside a person's stomach at the stomachwall to secure the distal end of said gastrostomy tube inside thestomach.

In another aspect of the disclosure, a kit of parts for constructing abariatric device as described herein comprises a gastrostomy tube and afeeding tube assembly as described herein.

In another aspect of the disclosure, a method for reducing the weight ofa person comprises installing a bariatric device disclosed herein insaid person's stomach and limiting the amount of food that passes thestomach into the duodenum using said device to evacuate orally consumedfood and directly deposit nutrition to the person's intestinal tractdownstream of the stomach.

In another aspect of the disclosure, the present invention provides amethod for reducing the weight of a person for cosmetic (i.e.non-therapeutic) purposes using a bariatric device disclosed herein, themethod comprising limiting the amount of food that passes the stomachinto the duodenum using said device to evacuate orally consumed food anddirectly deposit nutrition to the person's intestinal tract downstreamof the stomach.

In another aspect of the disclosure, a method for delivering nutrientsto a person comprises installing a bariatric device disclosed herein insaid person's stomach and using said device to evacuate orally consumedfood and directly deposit nutrition to the person's intestinal tractdownstream of the stomach.

In another aspect of the disclosure, a method for installing a bariatricdevice as disclosed herein in a person, comprises (i) inserting saidgastrostomy tube into the person's stomach and securing the gastrostomytube in place by expanding said gastrostomy tube anchor (e.g. inflatinga gastrostomy balloon); and (ii) inserting said feeding tube assemblythrough the person's stomach into the duodenum and securing said feedingtube in place by expanding said first feeding tube anchor after thepyloric sphincter (e.g. inflating a first feeding tube balloon after thepyloric sphincter).

In another aspect of the disclosure, a method for replacing agastrostomy tube as described herein with a replacement gastrostomy tubeas described herein, comprises (i) retracting said gastrostomy tubeanchor and removing said gastrostomy tube and (ii) inserting areplacement gastrostomy tube and expanding the gastrostomy tube anchorof the replacement gastrostomy tube.

In another aspect of the disclosure, a method for replacing a feedingtube assembly as described herein with a replacement feeding tubeassembly as described herein, comprises (i) retracting said firstfeeding tube anchor (and, if present, retracting said second feedingtube anchor) and removing said feeding tube assembly and (ii) insertinga replacement feeding tube assembly and expanding the first feeding tubeanchor (and, if present, expanding said second feeding tube anchor) ofthe replacement feeding tube assembly.

These and other aspects and advantages of the invention described hereinwill be better understood and appreciated by those skilled in the art byreference to the accompanying drawings briefly described below inconjunction with the following detailed description, wherein certainpreferred embodiments including the best mode are described. It is to beunderstood that the specific devices and processes illustrated in theattached drawings and described in the following detailed descriptionare exemplary embodiments of the inventive concepts defined in theclaims below. Hence, specific dimensions and other physicalcharacteristics relating to the embodiments disclosed herein are to beregarded as illustrative in nature and not as restrictive, unless theclaims expressly state otherwise.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A is a perspective view of a trans-abdominal bariatric deviceconstructed in accordance with the teachings of the present disclosure;

FIG. 1B is a cross section diagram of the bariatric device of FIG. 1A;

FIG. 2 is a diagram illustrating the bariatric device of FIG. 1 anchoredin the stomach of a human being; and

FIG. 3 is a diagram illustrating a pump that can be attached to thebariatric device of FIG. 1 to evacuate food from a person's stomachthrough the gastrostomy tube.

FIG. 4 is a diagram illustrating an external view of the feeding tubeassembly of the bariatric device of FIG. 1 installed in the stomach of ahuman being; and

FIG. 5 is a diagram illustrating an internal view of the bariatricdevice of FIG. 1 installed in the stomach of a human being.

FIG. 6 is a further diagram illustrating an internal view of thebariatric device of FIG. 1 installed in the stomach of a human being.

FIG. 7 is a diagram illustrating the proximal end of the feeding tubeassembly.

DETAILED DESCRIPTION

The following detailed description is presented to enable one ofordinary skill in the art to make and use the invention and toincorporate it in the context of particular applications. It is to beunderstood that the specific devices and processes illustrated in theattached drawings and described in the following specification areexemplary embodiments of the inventive concepts defined in the claimsbelow. Various modifications, as well as a variety of uses in differentapplications, will be readily apparent to those skilled in the art.Thus, specific dimensions and other physical characteristics relating tothe embodiments disclosed herein are not to be considered as limiting,unless the claims expressly state otherwise and the invention is notintended to be limited to the embodiments presented, but is to beaccorded the widest scope consistent with the principles and novelfeatures disclosed herein.

The present disclosure provides means and methods for safely inducingweight loss in overweight and obese individuals. The means and methodsdisclosed herein provide an easy-to-use, trans-abdominal bariatricdevice and procedure for strictly controlling the amount of food andnutrition entering a person's gastrointestinal tract that do not requirerescission or rerouting of the person's organs or tissues. The bariatricdevice disclosed herein is designed to be inserted through the abdominaland stomach walls and generally comprises a feeding tube assemblyslidably nested within a larger gastrostomy tube. The device can beinstalled in a subject with minimal surgery and requires minimalrecovery time. In general, the gastrostomy tube is inserted and anchoredin the stomach by an inflatable balloon, while a terminal end of thefeeding tube that protrudes from the gastrostomy tube is inserted andanchored in the duodenum by an inflatable balloon positioned after thepyloric sphincter, or by two inflatable balloons positioned on eitherside of the pyloric sphincter. Due to the large diameter of thegastrostomy tube, the bariatric device will be much less likely to clogwhen used to evacuate ground foods from the stomach.

Optionally, the feeding tube assembly is at least partially nestedwithin the gastrostomy tube. By “at least partially nested within thegastrostomy tube” we mean that at least a part of the feeding tubeassembly is positioned within the gastrostomy tube, for example, in theinterior of the gastrostomy tube or inset into a sidewall of thegastrostomy tube. The feeding tube assembly may be accommodated in atube support channel/track/slot provided on or in the sidewall of thegastrostomy tube, preferably such that the feeding tube can sliderelative to the gastrostomy tube within the tube support channel. Insuch embodiments, the tube support channel may extend along more than10%, more than 20%, more than 30%, more than 40%, more than 50%, morethan 60%, more than 70%, more than 80% or more than 90% of thegastrostomy tube. Advantageously, accommodating the feeding tubeassembly within a tube support channel extending along the gastrostomytube restricts lateral movement of the feeding tube assembly, thusreducing the propensity of the feeding tube to become dislodged from theduodenum. Such a tube support channel may be in an interior sidewall ofthe gastrostomy tube, or may be in an exterior sidewall of thegastrostomy tube. The tube support channel may open onto the interior ofthe gastrostomy tube, or may open to the exterior of the gastrostomytube. The gastrostomy tube includes an aspirating channel/lumen foraspirating material from a patient's stomach. In embodiments in whichthe gastrostomy tube includes a tube support channel, the tube supportchannel may be separate from the aspirating channel.

Turning now to the drawings, wherein like reference numbers refer tolike elements, FIG. 1A depicts an exemplary trans-abdominal bariatricdevice 1 constructed in accordance with the present disclosure. Thebariatric device 1 comprises a gastro-duodenal feeding tube assembly 20nested at least partially inside a larger diameter, generally hollowgastrostomy tube 10, and at least two balloons. In one embodiment, thedevice comprises three balloons. The balloons are made of medical gradematerials standard to the industry and compliant with medical standards,such as silicone. The diameter of the gastrostomy tube may range from0.5 cm to 5.0 cm, for example, 0.5 cm to 4.0 cm, 0.5 cm to 3.0 cm, 1.0cm to 2.5 cm, or 1.5 to 2.5 cm. In some embodiments, the diameter of thegastrostomy tube is approximately 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6,1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0,3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4,4.5, 4.6, 4.7, 4.8, 4.9, or 5.0 centimeters. In one embodiment, thegastrostomy tube is approximately 2.0 cm. The large diameter of thegastrostomy tube 10 facilitates the evacuation of thick, highconsistency or high viscosity foods, including ground solid foods.

As shown in FIG. 1B the feeding tube assembly 20 comprises a hollowfeeding tube 21 and two hollow balloon inflation tubes 22, 23, held withchannels running along the feeding tube assembly. In other embodimentsthe feeding tube and hollow balloon inflation tubes may be integrallyformed as part of the feeding tube assembly, i.e. the feeding tube andfirst and second balloon inflation tubes may be individual lumens formedas part of the feeding tube assembly body. In one embodiment, thefeeding tube assembly has at least one balloon in communicationtherewith. The feeding tube assembly 20 can be inset or nested in andrunning parallel to an outside wall of the gastrostomy tube 10. In theembodiment shown, the outer wall of the gastrostomy tube 10 contains atube support channel having a space 29 and overhanging lips thatpartially encompasses the smaller feeding tube assembly 20. However, inother embodiments, the gastrostomy tube 10 may completely encompass thefeeding tube assembly 20. In certain embodiments, the feeding tubeassembly 20 has a generally elliptical cross section. In otherembodiments, the cross section of the feeding tube assembly 20 may beirregular. More generally, the cross section of the feeding tubeassembly 20 may be non-circular. When the cross-section of the feedingtube assembly 20 is non-circular, the assembly can be accommodated in atube support channel having a corresponding shape which limits orprevents rotation of the feeding tube assembly relative to thegastrostomy tube 10. Advantageously, this restricted rotational movementreduces the chances of the feeding tube assembly becoming twisted anddislodged in a patient's stomach. When properly combined, the feedingtube assembly 20 is able to freely slide against the gastrostomy tube 10through the space 29. In some embodiments, the gastrostomy tube 10 mayinclude a releasable lock designed to restrict the sliding movement ofthe feeding tube assembly 20 within the space 29 and retain the assemblyin position against the wall of the gastrostomy tube until the lock isreleased. In certain embodiments, the releasable lock is disposed on theproximal end 11 of the gastrostomy tube 10. This arrangement allows thegastrostomy tube 10 or feeding tube assembly 20 to be removed oradjusted as needed without the need to remove any other components ofthe bariatric device 1 by simply releasing the lock and sliding therelevant tube in and out of position. This makes installation of thebariatric device 1 easier and less invasive than prior art devices andmethods. It also makes it easier to clean both the gastrostomy tube 10and stoma through which the tube extends, since the gastrostomy tube 10can be temporarily slid out of position to facilitate cleaning withoutdisrupting the position of the feeding tube assembly 20. In the shownembodiment, the releasable lock is provided by the overhanging lips ofthe tube support channel, which “grip” the feeding tube assembly 20 whengastrostomy tube balloon 14 (discussed in relation to FIG. 2) isinflated. More specifically, to “lock” the feeding tube assembly 20 inplace, the gastrostomy tube balloon 14 is inflated so as to create aconstrictive force which squeezes the overhanging lips of the tubesupport channel towards one another and thus causes the tube supportchannel to “grip” the feeding tube assembly 20. To “unlock” the feedingtube assembly 20 the gastrostomy tube balloon 14 is (at least partially)deflated so as to cause the overhanging lips of the tube support channelto relax and loose their grip. Stated more generally, the releasablelock may be provided by a deformable jaw on the tube support channelwhich grips the feeding tube assembly when the gastrostomy tube isinflated.

Referring now to FIG. 2, there is illustrated a diagram of atrans-abdominal bariatric device 1 installed in a person with thegastrostomy tube 10 and nested feeding tube assembly 20 extendingthrough the abdominal wall 30 and stomach wall 35. The gastrostomy tube10 further comprises a distal end 12 and a proximal end 11. The proximalend 11 is disposed outside the patient's abdominal wall 30 and comprisesa lid 13 for sealing the proximal end 11 and a closeable button 15. Thebutton 15 is an outlet which may be connected to a vacuum pump formechanically evacuating by suction the contents of a person's stomachinto an attached disposable bag or other receptacle for disposal. Thedistal end 12 of the gastrostomy tube 10 remains open to and is disposedin the person's stomach. The distal end 12 is also attached to agastrostomy tube balloon 14 for anchoring the gastrostomy tube 10 inposition on the inside of the stomach. The balloon 14 can be inflatedthrough a gastrostomy tube balloon inflation tube (not shown) using theaccess point 16 located on the proximal end 11 of the gastrostomy tube10 between the lid 13 and the abdominal wall 30. The balloon 14 may befilled with liquid or gas, such as air, water or saline, which is movedthrough the inflation tube (not shown) into the balloon 14. Thegastrostomy tube balloon 14 may be inflated during installation orafterwards.

The nested feeding tube assembly 20 is attached to and extends beyondthe distal end 12 of the gastrostomy tube 10 into the patient'sduodenum. Like the gastrostomy tube 10, the feeding tube 21 has a distalend 25 and a proximal end 24, the proximal end 24 being located outsidethe abdominal wall 30 and sealed by a removeable cap. The distal end 25terminates in and remains open to the person's duodenum, and is held inposition by two feeding tube balloons 26, 27, including a distal balloon27 and a proximal balloon 26. The proximal balloon 26 is located beforethe pyloric sphincter and the distal balloon 27 is located after thepyloric sphincter. In the embodiment shown in the figure, the balloons26, 27 take the form of inflatable sleeves completely surrounding andintegrally formed with the feeding tube 21. To prevent occlusion of thefeeding tube 21 by the pressure of the inflated balloons 26, 27, thesections of the feeding tube 21 inside balloons 26 and 27 are maderelatively stiffer than other sections of the feeding tube 21. This canbe achieved, for example, by making the sidewalls of the feeding tube 21relatively thicker in these sections, selecting a different material forthese sections, and/or by subjecting these sections to a stiffeningtreatment. In other embodiments, the balloons 26, 27 may only partiallysurround the feeding tube 21, for example, each balloon may take theform of one or more inflatable cells or pockets distributed around thefeeding tube 21. Although the balloons 26, 27 are formed integrally withthe feeding tube 21 in the shown embodiment, it will be appreciated thatin other embodiments the balloons 26, 27 may be separately formed fromthe feeding tube 21, for example, each balloon 26, 27 may be a separateballoon attached to the feeding tube 21. In such embodiments, theballoons 26, 27 may be movable (e.g. slidable) relative to the feedingtube 21 over a limited range (e.g. so as to allow a single design to beadapted to suit different patients). For example, one or both balloons26, 27 may take the form of an inflatable sleeve which the feeding tubecan be threaded through, with the sleeves optionally held in positionrelative to the feeding tube by the constrictive force created when theballoons 26, 27 are inflated.

Each balloon 26, 27 is in communication with and is inflatable via oneof the inflation tubes 22, 23, which may be connected to an externalballoon inflation control device (not pictured). It will be appreciatedthat in alternative embodiments both balloons can be inflated via asingle inflation tube. The balloon inflation tubes 22, 23 are disposedparallel to the feeding tube 21 within the feeding tube assembly 20, andeach extends from outside the abdominal wall 30 to a respective balloon26, 27. When the feeding tube balloons 26, 27 are inflated, theyanchor/secure the feeding tube assembly 20 relative to the pyloricsphincter. In one embodiment, there is at least one feeding tube balloonanchoring the feeding tube assembly 20. However, there may be twofeeding tube balloons anchoring the feeding tube assembly, one on eitherside of the pyloric sphincter, so as to restrict forward and backwardmovement of the feeding tube through the pyloric sphincter.

Generally, in embodiments having two feeding tube anchors, said anchorsare separated by a distance of less than 15 cm, less than 12 cm, lessthan 10 cm, less than 8 cm, less than 6 cm or less than 4 cm. Forexample, the feeding tube anchors may be separated by between about 1 toabout 15 cm, between about 1 to about 10 cm, or between about 1 to about5 cm. Advantageously, spacing the feeding tube anchors by this distanceallows only a limited amount of movement of the feeding tube back andforth through the pyloric sphincter, which helps to prevent the feedingtube assembly from becoming dislodged. In the embodiment shown in thefigures, the distance separating the balloons is the distance measuredbetween the outer surfaces of balloons 26 and 27 at their point ofclosest approach.

When fully expanded the first and/or second feeding tube anchors mayhave a width of at least 5 mm, at least 10 mm, at least 12 mm, at least15 mm, at least 18 mm, at least 20 mm, at least 22 mm, or at least 25mm. For example, the feeding tube anchors may have a width of between 10and 25 mm, or between 15 and 25 mm. Advantageously, feeding tube anchorshaving these dimensions are wider than the diameter of the pyloricsphincter in the sphincter's open position, meaning that the positioningof the feeding tube is not affected by pyloric contractions. At leastone feeding tube anchor may be sufficiently wide in its fully expandedstate to substantially or completely occlude the duodenum. Such asituation is shown in FIG. 5, where feeding tube balloons 26 or 27occlude the duodenum 51 in their inflated states. This prevents thepassage of stomach contents to the duodenum 51, meaning thatorally-ingested food and stomach phlegm can be aspirated from thestomach through gastrostomy tube 10 without the need to aspirate furtherdown the digestive tract. Consequently, this provides a way ofcontrolling the amount of food reaching the lower digestive tract.

Suitably, the gastrostomy tube 10 does not enter the duodenum 51. As aresult, the gastrostomy tube 10 can be made relatively shorter and widerthan the feeding tube assembly 20, since it is not necessary for thegastrostomy tube to fit within the narrow duodenum 51. As describedabove, the relatively large diameter of the gastrostomy tube 10 reducesthe propensity of the gastrostomy tube to become clogged duringaspiration. Suitably, the length of the gastrostomy tube 10 which iswithin the body in use may be less than 75%, less than 50%, less than40% or less than 30% of the length of the feeding tube 21 which iswithin the body in use. By “length of the gastrostomy tube which iswithin the body in use” we mean the length as measured from the part ofthe gastrostomy tube 10 which abuts the patient's stomach wall 35 in use(e.g. the outer surface of a fully-inflated gastrostomy balloon closestto the proximal end 11 of the gastrostomy tube) to the distal end 12 ofthe gastrostomy tube 10. By “length of the feeding tube which is withinthe body in use” we mean the length as measured from the part of thegastrostomy tube which abuts the patient's stomach wall 35 in use to thedistal end 25 of the feeding tube 21.

To remove the gastrostomy tube 10, the gastrostomy balloon 14 isdeflated and the gastrostomy tube 10 is slid off of the feeding tubeassembly 20. A further gastrostomy tube can then be installed by slidingthe gastrostomy tube 10 onto and along the feeding tube assembly 20until the correct position is reached. The feeding tube balloons 26 and27 can remain inflated during this procedure, so as to retain thefeeding tube 21 in its position within the duodenum 51, allowing thegastrostomy tube to be replaced in a minimally invasive way.

Similarly, to remove the feeding tube assembly 20, the feeding tubeballoons 26 and 27 are deflated and the feeding tube assembly 20 is slidout of the gastrostomy tube 10. A further feeding tube assembly can thenbe installed by slotting the feeding tube assembly 20 through space 29until the correct position is reached. If the device includes areleasable lock holding the feeding tube assembly 20 in place, the lockshould be released before removal of the feeding tube assembly 20 fromthe gastrostomy tube 10. For example, in the shown embodiment, thegastrostomy balloon 14 is partially deflated so as to allow the feedingtube assembly 20 to be removed whilst still securing the gastrostomytube 10 in position, allowing the feeding tube assembly 20 to bereplaced in a minimally invasive way.

Referring now to FIG. 3, there is illustrated a diagram of a manual handpump 40 and a releasably attached disposable bag 49 suitable for usewith the trans-abdominal bariatric device 1 of FIG. 1. The pump 40comprises a squeezable bulb 47 having an inlet valve 45 and an outletvalve 46; an inlet tube 43; and an outlet tube 44. The bulb 47 isconnected to one end of the inlet tube 43 at the inlet valve 45, and oneend of the outlet tube 44 at the outlet valve 46. The opposite end 41 ofthe inlet tube connects to the button 15 (see FIG. 2) of the gastrostomytube 10 and the opposite end 42 of the outlet tube connects to adisposable bag 49. When connected to the bariatric device 1 and adisposable bag 49, a person may squeeze or compress the bulb 47 tosuction food out of the stomach and into the bag 49. When full, thedisposable bag 49 may be disconnected from the outlet tube 44, discardedand replaced with a new bag as needed. The type of vacuum pump used mayvary. Suitable pumps include manual as well as electric and batterypowered pumps, and the like. The type of pump used should providesuction strong enough to evacuate thick or viscous consumed food fromthe stomach, but not so strong as to damage tissue or organs.

Referring now to FIG. 4, there is provided a diagram illustrating asimplified external view of the feeding tube assembly of the bariatricdevice of FIG. 1 installed in the stomach of a human being. The feedingtube assembly 20 extends through the abdomen from outside the body toinside the stomach via a gastrostoma. The point of entry is sealed by apatch 60 through which the feeding tube assembly 20 extends. The feedingtube 21 through which controlled feeding is performed extends from thepatch 60 to a point outside the body. The exposed length of feeding tube21 may be adjusted to suit the person in which it is installed. Alsoextending outwardly from the patch 60 (outside the body) are theproximal ends of the two balloon inflation tubes 22, 23. These may beconnected to a balloon inflation control (not shown), which can be usedto selectively inflate the balloons.

Referring now to FIG. 5, there is provided a diagram illustrating aninternal view of bariatric device of FIG. 1 installed in the stomach ofa human being. A cross section of the bariatric device 1 is shown inplace of the patch 60 of FIG. 4. The gastrostomy tube 10 and nestedfeeding tube assembly 20 pass through the abdomen and stomach wall. Thegastrostomy tube 10 terminates in the stomach 52, while the feeding tube20 and one balloon inflation tube 22 continues through the stomach 52and pyloric sphincter 50 into the duodenum 51. The other ballooninflation tube, 23, terminates at the bottom of the stomach 52 at thepyloric sphincter 50. The feeding tube 21 terminates in the duodenum 51and is attached to two feeding tube balloons, 26, 27, the proximalballoon 26 located before the pyloric sphincter and the distal balloon27 located after the pyloric sphincter. Each balloon inflation tube 22,23 is in communication with a feeding tube balloon 26, 27. Each feedingtube balloon, 26, 27 is disposed on either side of the pyloric sphincter50. Inflation of the balloons via the balloon inflation tubes 26, 27anchors the feeding tube 21 in the duodenum 50. To form a completedbariatric device 1, a user slots the feeding tube assembly 20 throughthe space 29 of a gastrostomy tube 10, and gently slides the gastrostomytube 10 into position. Once in position, the gastrostomy balloon 14 ofthe gastrostomy tube 10 is inflated within the stomach, so as to anchorthe gastrostomy tube 10 in place (as shown in FIG. 2).

Referring now to FIG. 6, there is provided an alternative view of thebariatric device 1 of FIG. 5 installed in a patient. The figure showsgastrostomy tube 10 anchored within a patient's stomach by gastrostomyballoon 14, and feeding tube 21 nested within gastrostomy tube 10extending beyond the end of gastrostomy tube 10 into the duodenum. Thefeeding tube 21 is held in position by balloons 26, 27 which have beeninflated on either side of the pyloric sphincter 50 via inflation tubes22, 23.

Referring now to FIG. 7, there is provided a diagram of the proximal endof the feeding tube assembly 20, so as to illustrate how feeding tubeballoons 26 and 27 are inflated. Inflation tubes 22 and 23 are shownconnected to filling chambers 72 and 73 respectively, with the inflationtubes 22, 23 and filling chambers 72, 73 containing a balloon inflationfluid, in this case, a saline solution. Plungers 74 and 75 positionedwithin chambers 72 and 73 respectively are used to control the deliveryof fluid from the chambers 72 and 73 to the feeding tube balloons 26 and27 respectively. The plungers 74, 75 are both connected to a singlehandle 77, so as to allow the plungers to be compressed in a singlemovement. However, handle 77 can be removed to allow each plunger 74, 75to be independently actuated (e.g. to deflate one balloon whilst theother remains inflated). In the embodiment shown, the plungers 74, 75have been depressed from position D to position F so as to inflate theballoons 26 and 27 on either side of the pylorus so as to preventstomach contents from passing to the intestines. To deflate balloons 26and 27 the plungers 74, 75 can be lifted from position F to position D.In use, a patient may wish to allow delivery of some stomach contents tothe intestines for short periods; for example, when taking medication orwhen drinking To achieve this, the user can deflate balloon 26 bylifting plunger 74 and partially deflate balloon 27 by lifting plunger75, thus allowing passage of the desired contents from the stomach intothe intestines whilst the feeding tube 21 remains anchored in position.Once the desired contents have reached the intestines, the user canre-inflate balloons 26 and 27 by compressing plungers 74 and 75 again.This provides the user with good flexibility to control the materialreaching their intestines.

Interpretation

All references, including publications, patent applications, andpatents, cited herein are hereby incorporated by reference to the sameextent as if each reference were individually and specifically indicatedto be incorporated by reference and were set forth in its entiretyherein.

The use of the terms “a” and “an” and “the” and similar referents in thecontext of describing an invention (especially in the context of thefollowing claims) are to be construed to cover both the singular and theplural, unless otherwise indicated herein or clearly contradicted bycontext. The terms “comprising,” “having,” “including,” and “containing”are to be construed as open-ended terms (i.e., “including, but notlimited to,”) unless otherwise noted. Recitation of ranges as valuesherein are merely intended to serve as a shorthand method of referringindividually to each separate value falling within the range, unlessotherwise indicated herein, and each separate value is incorporated intothe specification as if it were individually recited herein. All methodsdescribed herein can be performed in any suitable order unless otherwiseindicated herein or otherwise clearly contradicted by context. The useof any and all examples, or exemplary language (e.g., “such as”)provided herein, is intended merely to better illuminate the inventionand does not pose a limitation on the scope of the invention (i.e.,“such as, but not limited to,”) unless otherwise claimed. No language inthe specification should be construed as indicating any non-claimedelement as essential to the practice of the invention.

While the disclosure above sets forth the principles of the inventiondisclosed herein, with examples given for illustration only, thoseskilled in the art will appreciate from the foregoing that variousadaptations and modifications of the just described embodiments can beconfigured in various respects without departing from the scope andsprit of the invention. The inventors expect that skilled artisans willemploy various obvious changes in form and detail, and the inventorsintend for the invention to be practiced other than as specificallydescribed herein. Accordingly, the invention includes all equivalentsand usual and obvious modifications of the subject matter recited in theclaims appended hereto as permitted by applicable law. Moreover, anycombination of the above-described features and elements in all possiblevariations hereof is encompassed by the invention unless otherwiseindicated herein or otherwise clearly contradicted by context.Therefore, it is to be understood that the invention must be measured bythe scope of the appended claims and not by the description of theexamples or the preferred embodiments.

What is claimed is:
 1. A bariatric device, comprising: (a) a gastrostomytube having a proximal end and a distal end; (b) a feeding tubeassembly, said assembly including a feeding tube having a proximal endand a distal end; (c) a gastrostomy tube anchor attached to saidgastrostomy tube and designed to be expanded inside a person's stomachat the stomach wall to secure the distal end of said gastrostomy tubeinside the stomach; and (d) a first feeding tube anchor means attachedto said feeding tube assembly, said first feeding tube anchor designedto be expanded after a person's pyloric sphincter so as to secure thedistal end of the feeding tube in a person's duodenum.
 2. A bariatricdevice according to claim 1, wherein the first feeding tube anchor is afirst feeding tube balloon designed to be inflated after a person'spyloric sphincter, and the feeding tube assembly includes a firstballoon inflation tube, wherein the first feeding tube balloon is incommunication with said first balloon inflation tube.
 3. A bariatricdevice according to claim 2, wherein the gastrostomy tube anchor is agastrostomy balloon which is designed to be inflated inside a person'sstomach.
 4. A bariatric device according to claim 1, further comprisinga second feeding tube anchor attached to said feeding tube assembly,wherein said first and second feeding tube anchors are designed to beexpanded on either side of a person's pyloric sphincter so as to anchorthe distal end of said feeding tube in a person's duodenum.
 5. Abariatric device according to claim 3, further comprising a secondfeeding tube anchor, wherein said first and second feeding tube anchorsare designed to be expanded on either side of a person's pyloricsphincter so as to anchor the proximal end of said feeding tube in aperson's duodenum.
 6. A bariatric device according to claim 5, whereinthe second feeding tube anchor is a second feeding tube balloon designedto be inflated before a person's pyloric sphincter, and the feeding tubeassembly includes a second balloon inflation tube, wherein the secondfeeding tube balloon is in communication with said second ballooninflation tube.
 7. A bariatric device according to claim 6, wherein thefeeding tube assembly is at least partially nested within saidgastrostomy tube.
 8. A bariatric device according to claim 7, whereinthe feeding tube assembly is slidably nested within said gastrostomytube.
 9. A bariatric device according to claim 8, wherein thegastrostomy tube includes a releasable lock designed to restrict thesliding movement of the feeding tube assembly relative to thegastrostomy tube.
 10. A bariatric device according to claim 8, whereinthe feeding tube assembly is accommodated in a tube support channelprovided in the sidewall of the gastrostomy tube, and wherein thefeeding tube is slidable relative to the gastrostomy tube within thetube support channel.
 11. A bariatric device according to claim 10,wherein the tube support channel extends along 80% or more of thegastrostomy tube.
 12. A bariatric device according to claim 10, whereinthe cross-section of the feeding tube assembly is non-circular, and thetube support channel has a corresponding shape which limits or preventsrotation of the feeding tube assembly relative to the gastrostomy tube.13. A bariatric device according to claim 6, wherein said first andsecond feeding tube balloons are separated by a distance of betweenabout 1 to about 15 cm.
 14. A bariatric device according to claim 6,wherein said first and second feeding tube balloons are separated by adistance of between about 1 to about 5 cm.
 15. A bariatric deviceaccording to claim 6, wherein said first and second feeding tubeballoons have a width of between 10 mm to 25 mm.
 16. A bariatric deviceaccording to claim 6, wherein at least one of said first and secondfeeding tube balloons is sufficiently wide in its fully expanded stateto occlude the duodenum in use.
 17. A bariatric device according toclaim 6, wherein the diameter of the gastrostomy tube is between 0.5 to5.0 cm.
 18. A bariatric device, comprising: (a) a gastrostomy tubehaving a proximal end and a distal end; (b) a feeding tube assembly atleast partially nested within said gastrostomy tube, said assemblyhaving a proximal end and a distal end and including a feeding tube andfirst and second balloon inflation tubes; (c) a gastrostomy balloonattached to said gastrostomy tube and designed to be inflated and anchorthe proximal end of said gastrostomy tube inside a person's stomachwall; and (d) first and second feeding tube balloons in communicationwith said first and second balloon inflation tubes, said first andsecond balloons designed to be inflated on either side of a person'spyloric sphincter and anchor the distal end of said feeding tube in aperson's duodenum.
 19. A feeding tube device, comprising a feeding tubehaving a proximal end and a distal end, a first balloon inflation tube,and a first feeding tube balloon in communication with said firstballoon inflation tube, said first balloon designed to be inflated aftera person's pyloric sphincter so as to anchor the distal end of saidfeeding tube in a person's duodenum.
 20. A feeding tube device accordingto claim 19, further comprising a second feeding tube balloon, whereinthe first and second feeding tube balloons are designed to be inflatedon either side of a person's pyloric sphincter so as to anchor thedistal end of the feeding tube in a person's pyloric sphincter.
 21. Agastrostomy tube suitable for receiving a feeding tube assembly,comprising a proximal and a distal end, a sidewall, and a tube supportchannel on or in the sidewall for receiving said feeding tube assembly,and further comprising a gastrostomy tube anchor attached to saidgastrostomy tube and designed to be expanded inside a person's stomachat the stomach wall to secure the distal end of said gastrostomy tubeinside the stomach.
 22. A kit of parts for constructing a bariatricdevice according to claim 6, comprising a gastrostomy tube and a feedingtube assembly.
 23. A method for reducing the weight of a person,comprising installing a bariatric device according to claim 1 in saidperson's stomach and limiting the amount of food that passes from thestomach into the duodenum using said device to evacuate orally consumedfood and directly deposit nutrition to the person's intestinal tractdownstream of the stomach.
 24. A method for reducing the weight of aperson for cosmetic purposes using a bariatric device according to claim1, the method comprising limiting the amount of food that passes fromthe stomach into the duodenum using said device to evacuate orallyconsumed food and directly deposit nutrition to the person's intestinaltract downstream of the stomach.
 25. A method for delivering nutrientsto a person, comprising installing a bariatric device according to claim1 in said person's stomach and using said device to evacuate orallyconsumed food and directly deposit nutrition to the person's intestinaltract downstream of the stomach.
 26. A method for installing a bariatricdevice according to claim 1, comprising: (i) inserting said gastrostomytube into the person's stomach and anchoring the gastrostomy tube inplace by expanding said gastrostomy tube anchor; and (ii) inserting saidfeeding tube assembly through the person's stomach into the duodenum andsecuring said feeding tube in place by expanding said first feeding tubeanchor after the pyloric sphincter.
 27. A method for replacing agastrostomy tube in a bariatric device according to claim 1, comprising:(i) retracting said gastrostomy tube anchor and removing saidgastrostomy tube; and (ii) inserting a replacement gastrostomy tubehaving the features described in claim 1 and expanding the gastrostomytube anchor of the replacement gastrostomy tube.
 28. A method forreplacing a feeding tube assembly in a bariatric device according toclaim 1, comprising: (i) retracting said first feeding tube anchor andremoving said feeding tube assembly; and (ii) inserting a replacementfeeding tube assembly having the features described in claim 1 andexpanding the first feeding tube anchor of the replacement feeding tubeassembly.